Provider First Line Business Practice Location Address:
6020 SANTO RD
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92124-1195
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-467-0929
Provider Business Practice Location Address Fax Number:
858-467-0922
Provider Enumeration Date:
09/14/2006